Public attitudes to the provision of adult social care in the UK transcript

Good afternoon, everyone, and thank you very much for joining our webinar. We have a very distinguished panel for you today, and the webinar promises to be very interesting. Firstly, I'll introduce myself. My name is Craig Watkins, and I'm the CEO for Varian in the UK, and today I have the privilege of being your host for this event.

Today's webinar is on the topic of the public's attitudes to the provision of adult social care. We thought it very timely to do research on this topic, given the government's independent commission on social care, led by Baroness Louise Casey, has recently kicked off. Today's webinar is being recorded, and after the event, you'll be able to access the recorded version on our website. We encourage you to revisit the content and to feel free to share it with colleagues who may or may not have been able to attend.

We welcome your comments and questions, so please use the Q&A chat function that you'll find at the bottom of your screen in order to submit questions. Please feel free to submit them at any time whilst the speakers are talking, and then we'll try to address as many of them as we can during the Q&A section towards the end of the webinar.

So now, to introduce our panel. I'm absolutely delighted to be able to welcome Sir Andrew Dilnot to our panel today. Some of you may know that Sir Andrew led the commission review into adult social care that reported back in 2011. Sir Andrew has a long and distinguished career. Amongst many achievements, he was the Director of the Institute for Fiscal Studies, he was the Chair of the UK Stats Authority, and perhaps more intriguingly, the founding presenter of a Radio 4 series on the beauty of numbers.

In addition to Sir Andrew, we have Ben Humber. Ben heads up the Population Studies team at Varian. Previously, Ben had a notable 20-year career in the Government Statistical Service, leading the 2021 design and build phase for the census and being the Chief Statistician of the Cabinet Office. Ben is also a fellow of the Royal Statistical Society and a member of the National Statistics Advisory Group. Ben will take us through our approach to the research and some context for the adult social care debate.

We next have Vicky Petri, who is a senior director at Varian, and previous to joining us, was Head Researcher at the Department for Education, where she was heavily involved in children's social care policy and at DWP, helped build the evidence base for private sector, sorry, for private pension reform and the automatic pension enrollment policy. Vicky will be taking us through the key findings of our research.

And finally, we have Lucy Joyce. Lucy is the Head of Policy Development and Implementation at Varian, and Lucy led the deliberative research that our organization carried out as part of Sir Andrew's review back in 2010 and 2011. So we'll be able to give a perspective on the differences between the findings that we have. So, without further ado, I would now like to invite Ben Humberstone to kick off the presentations.

Thanks very much, Craig. We're really excited to share the results of our poll on public attitudes to the provision of social care. The polling was conducted for a week in April 2025 among 1,285 adults aged 18 and over in Great Britain. We used the Varian random probability panel, Public Voice. We refer to as gold standard sampling. What makes this different from other panels that you may encounter is that members are randomly sampled and invited to join the panel, so it reflects the makeup of the UK population. This differs from the self-selected approach that you'll see with many other panels. Polling a representative panel of randomly sampled individuals means that we can turn around high-quality results more quickly than other surveys of similar quality. The membership by invite helps limit the potential for fraud and bias and helps ensure that we've got a representative group responding. We treat our panelists with respect and only ask them to complete a small number of surveys a month, alongside decent incentives. So why are we confident in its accuracy?

Next slide please, Rachel. We have an exceptional track record using Public Voice. We were the only company to use a probability panel for polling during the 2024 general election campaign, and we produced the most accurate final poll of voting intentions, as you can see here, measured by total absolute error. The chart on the left shows analysis by Southampton University of all major final polls before the 2024 general election and further demonstrates why we have confidence in the results produced by Public Voice. The panel is used extensively across all of our clients, and you can see some of them here. We use Public Voice to provide insight into some of the most important debates in society, including, for example, public perceptions of AI and some other key policy areas. Before I hand over to Vicky, who will cover the results, as Craig has said, it's important to set social care in context.

So why are we focusing on social care today? The demand for social care is increasing year on year, and this is driven in part by the changing demographics of the UK. As the chart here shows, the current population projection for the UK shows a growing and aging population. The fastest growing section of the population is those aged 75 and over, growing by 20% over the next 10 years and nearly 50% over the next 20 years. This will put substantial additional pressure onto the social care sector, with increasing demand driving the need for more funding. Adequate provision of social care is critical for NHS efficiency, enabling timely, supported discharge of patients from hospital. A lack of social care availability can mean that it is difficult to safely discharge patients with an appropriate package of care, increasing the length of stay and putting additional pressure on the health service, not to mention adding stress for patients and families.

Part of the challenge with social care capacity are the severe workforce shortages in the care sector. According to Skills for Care, in 23/24, the vacancy rate in social care was around 8.3%, well over twice the UK average of 3.5% in other sectors. In addition, staff turnover was 25% in the same year. Social care has been recognized as a political priority, as Craig has mentioned, and is squarely on the government's agenda with the launch of Baroness Casey's commission, following on from Sir Andrew's commission back in 2011. Given the importance of this topic to the population in the UK and the political agenda, we've used Public Voice to gauge what the public really think about social care, to understand effectively the thinking behind the numbers. I'll now pass on to Vicky, who will explain what we've found.

Thanks, Ben. That's really a great introduction. I think it really, really shows us the pressures that are coming in terms of on the adult social care system, but also with the growing and changing demographics, it's a real challenge, I think, that's going to face this country in the future. So we've got lots and lots of findings from our Public Voice poll. I'm only going to cover a few of these today, but the good news is there is a report to supplement this that you can all access afterwards, so do get in contact if you want to see some more of the detailed findings. But I think we're all keen to hear what Sir Andrew has to say and also get a bit of debate going and have a conversation around some of this. So we're happy for you to share your observations kind of as I run through these findings.

What I'm going to do is I'm going to present the differences by demographics where they are relevant. So interestingly, there were not a lot of differences in terms of the attitudes to the adult social care service and provision shown. There were some differences by age, and I'll bring them out, but I think it's an interesting finding in itself that the kind of the concerns or the attitudes are very similar across all demographic groups. So what do we ask people? So the first question we asked is, could people tell us about their top three priorities for UK government in terms of tackling to improve public life in the UK? Unsurprisingly, maybe, adult social care was quite low down that list, with 12% of people mentioning it as one of their three most important priorities. So for younger people, things like affordable housing were much more important in terms of telling the government to tackle to help improve their lives. But across the board, reducing the cost of living for households was the thing that really, really mattered to people. I think these findings give us a little sense of the challenge that we're facing in terms of adult social care reform or changes to the system, because basically people want to solve the issues that are really important to them in their day-to-day lives. So the things that are coming towards them very much into their future are not seen as their priority, and to be honest, we can't really blame them when the cost of living is potentially the thing that's concerning them most.

Next slide, please. So given the finding we've just discussed about lower priority, it's not surprising then that very few adults who took part in our poll had plans in place to pay for their future care. 85% of people surveyed said they had no plans in place to pay for the adult social care that they may need in the future. But interestingly, 62% said they were concerned about paying for adult social care that they may need in the future. So if we just take a step back here and see what's kind of driving this, there may be some sense of inertia here, so basically people are not sort of putting plans in place, but maybe that's because they simply don't know what they need to do or what those plans might look like. It's hard to plan for something that's very uncertain or you don't really know what you'll need in the future or what that future holds for you. Interestingly, younger age groups in the sample were less concerned about paying for adult social care, which suggests there's a challenge that's kind of just not even on their radar yet. But as I said, who can blame them when things like cost of living or affordability of housing is much more in their immediate list of needs? We did do some analysis by people who'd said they had experienced the adult social care system, so whether that's for themselves or for friends or for relatives, right now or in the kind of shorter past, so like in the last 5 years or so. And again, those with some experience of the care system were more worried about funding it. They kind of know the challenges, I guess. If you've experienced something, you probably know more about what those costs are or the reality of navigating that funding system. If you know that, you're potentially more likely to worry about your own future.

Next slide, please. So so far, we've seen that the adult social care is a low or rather not a high priority, and the majority of people have no plans in place, but a good number of them are really worried about how they're going to pay for it. So we then asked a series of questions about who is responsible for organizing adult social care, because it's really important to understand people's knowledge or ability to kind of understand how the current system works. So when I talk about responsibility in this context, I'm talking about responsibility for organizing adult social care. I'm not talking about funding. We're going to come on to that in a minute because that's a separate and quite interesting topic in itself. So who is responsible for organizing it? So respondents could give us more than one answer, and 69% said local councils, which is right. We then asked who should be responsible for organizing adult social care, and 63% said local councils and national government, so a combination of both of those organizations in this space. So what does that, I guess, tell us? It tells us there's an appetite for more of a role for national government in terms of organizing adult social care. What could be driving this? We could, we could make endless guesses, and I'd be interesting to hear views from people on the call when we get to the questions at the end. But it might be that there's low levels of trust in local councils to organize things, whether people are having difficult experiences of bin collections or school provision, and it might mean that they just feel that there needs to be some sort of national government role in this space. It may be that they just simply are answering this question with a view that it needs to be on the kind of the national government agenda so that the funding system's correct.

Next slide, please. So this demonstrates a very similar finding to the one I've just discussed, and it kind of indicates that shared responsibility between national and local government is favored by the people who took part in our poll, but with some appetite for a shared role with the private sector. So we haven't really explored this in a lot of detail, and I think that's something that potentially a future piece of research would be useful to do, and maybe Sir Andrew will have thoughts on that when he comes to his reflections about whether having kind of private sector in this space is a viable option given the current system.

Next slide, please. So now we move on to the issue of adult social care funding. So for those of you who don't know, the capital limit, or safety net, as it's often known, is currently set at £23,250. So people with savings and assets more than that have to contribute to their cost of care. So we spent some time, as all researchers do, trying to think about how best to pose that question to people because the financial assessment process is incredibly complex. So financial assessment for adult social care takes into account income, assets, savings, capital assets, whether you've got a spouse or a partner still living in your home, short-term, long-term care—it's a really complicated thing to navigate. So we simplified the question, and we only referenced the safety net amount as savings under £23,500, and this was to get that initial view on fairness of the funding system. So what did we find? So we found that the capital limit was seen as unfair, with 61% saying it was very unfair or unfair, and 97% saying the limit was too low, which means that there is definitely a view that too many people have to pay towards their adult social care. Alternatively, you could see this through the lens that people find it unfair because such a small amount of their assets are protected from the future funding of their adult social care, so in that sense, the bar just isn't high enough.

Next slide, please. So currently, there's no cap on the amount that people have to pay towards their adult social care, so we therefore asked them about the fairness that there is absolutely no upper limit, and 61% said that was very unfair or unfair that it was not capped, and 82% thought there should be a maximum limit. So there's a real sense when people are asked, they felt that the system was unfair, both in terms of the safety net and the cap.

Next slide, please. So we then asked a series of questions around, well, who should be paying for adult social care? And there was a real mixed view. So 46% said that the government should pay for all adult social care, ensuring it's completely free for everybody that needs it, and 50% felt that adult social care should be free for those who cannot afford to pay it for themselves, but those that can afford to pay for it should pay for it, which kind of indicates amongst that 50%, there is a bit of support for means testing, and that's kind of welcomed. But the view really, really is quite mixed, and a very small percentage of people said that it should be paid for by individuals.

Next slide, please. So then we tested a few ideas around funding because people may, you know, want to think about if if it's not paid for by government, or if it is supported by government, what that future system might look like for them. So the first idea we moved was a government-run insurance scheme where everyone contributes monthly to a dedicated fund for adult social care, and 59% of people supported that government-run scheme. The second idea that we presented there was no government scheme. If there was no government scheme, would they be interested in buying a private insurance? And 40% said that they would be interested in private insurance if a government scheme didn't exist so support for both schemes was high, but they were higher with the older age group that we surveyed. So you could surmise part of this is reflecting again that sort of present bias that we talked about earlier: paying into something for the future or imagining your future self is much, much harder for that younger generation, where cost of living or housing affordability is more of a priority for their day-to-day income. Next slide please.

So, just to summarize before I hand back to Craig, adult social care was a lower priority, or rather not a high priority, for people that we spoke to. This is perhaps unsurprising due to present biases; affordability and reducing cost of living being seen as up there as really important for government to tackle. But there was a concern amongst people we polled about how they will fund adult social care for themselves in the future, and this sits alongside the finding that 85% said they currently have no plans in place. Both local and national government should be responsible for organizing, and national government should support funding. There was some support for the private sector having a role to play, but I really think we need to unpack that with further research to just understand what people think about that in context. Means testing is welcomed by some, but it really is a mixed view about who should fund it. But there's no doubt that the current system is seen as unfair, partly due to the safety net and also due to the fact there's no cap being placed on the amount that people need to spend. Then, in terms of ideas for funding, there was definite support for a government-run insurance scheme or a private insurance scheme. And this might go some way to solve the inertia or enable people to move that kind of concern into action. But the appetite for this was greater amongst older people, so there is definitely a challenge, or might be a challenge, for the future in thinking about how we engage younger people in any solution that we come up with. I'll pass back to Craig.

Thank you, Vicki. Vicki, before I pass to Andrew, can I ask whether or not we saw any demographic differences in the data in terms of views from, I mean you've mentioned obviously the age point, but in terms of differences between genders? So we did, we did see something, and it was around people's appetite to discuss financial planning or care plans for the future, where women were more likely to be sort of keen or more likely to want to discuss those things. So again, I think there is something definitely around people's lack of desire to discuss things that might affect them in the future, or just that whole financial planning conundrum that people face. They don't want to talk about money, maybe they don't want to talk about things that might affect them in the future. But there was definitely something for women to feel more kind of willing to discuss those things. Okay, and in terms of the other findings that you've presented then, no differences that were material. No, just just by age. And as we said, it's predictable. So the younger you are, the less likely you are to think about the future. The closer you are, the more likely you are to think of adult social care or funding to be an important issue, which is of interest of itself, because we generally see quite a lot of differences between different groups and actually this was quite consistent, which shows, yeah, okay.

Thank you very much, Vicki. No, and now I'm delighted to invite Sir Andrew to respond to Ben and Vicki's presentations and to give his perspective on the kind of the issues facing us. So over to Sir Andrew. Thank you so much, Craig, and thanks to Ben and Vicki. I'm really delighted this work is being done. One of the things that's striking about social care is it's a potentially very important thing for all of us, but we hear very little about it. We don't know very much about it. We don't have very good data about it on the whole. And this kind of data about people's perceptions and views is really critical. One thing in all debates like this about framing, and I want to challenge the framing we normally have around social care. We often hear people talk about the burden of aging, the challenge of paying for social care, how difficult. I think we should turn it completely upside down. It's fantastic. The great triumph of the last 150 years across the world has been the staggering increase in how long people live. In 1901, the 1901 census, there were 61,000 people aged 85 and over in England. By 2011, there were 1.447 million of them, and by 2030, we expect there to be 3 million people aged 85 and over in England. This is extraordinary. This is what we want. You know, all of our lives, they're not focused on trying to make the economy grow because we want to make the economy grow, or trying to make our hospitals efficient because we want hospitals to be efficient for their own sake. We want this because we want more human flourishing. And one of the staggering changes of the last century and a half has been a massive increase in human flourishing, in particular through people living longer. So I'm now 64. I really want to Ben showed numbers for people aged 75 and over. I really want to be in Ben's chart in 11 years' time because the alternative is I'll be dead. Much, much better to be alive than dead. And it's important also to remember that many people benefiting from receiving social care have really flourishing, happy, fruitful, good lives. So we should try to stop thinking about social care as something very tricky and difficult and uncomfortable, and recognize that it can be marvelous, and indeed it's the consequence of something marvelous.

These results are extremely interesting. There isn't much in here that is a surprise, actually. It's consistent with earlier versions of similar sorts of questions that have been asked, but it is really important. I think it's not widely understood. One of the things that I was most struck by is that people say they're not making plans even though they're worried about it. Now, it could be that they're not making plans because they're feckless, but that's not why they're not making plans. They're not making plans because it's not obvious what plans you can make. If you are going to end up because you have low income and wealth in the means-tested system, then you're going to end up in the means-tested system. You don't need to make any plans for that. If you're not going to end up there, there's not really very much you can do. What the system at the moment is encouraging you to do is make sure you've got enough savings in case you end up with a significant social care need. Well, what might that number be? Well, for one person, let's imagine you're on your own, and you need residential care for a bit more than 10 years: a million pounds. Let's imagine there are two of you and you both need that: £2 million. Is it feasible for very many people in a country like this to have precautionary saving of 2 million? Of course it isn't. There's nothing that most people can do about it. So for most people, the prospect of needing social care is, if your social care need becomes established, then it's a bit like standing in the middle of the road and there's a lorry driving towards you, and the best you can hope for is that you die before it hits you. Well, that's not a very clever way of arranging things. So part of the reason, I think, for people not making any plans is they don't know what plans they could possibly make. There is no private sector insurance available for this in this country, and the state isn't. So they're not making plans, but not because they're foolish or not paying attention, but because there is no plan to make. And this is going to affect most of us. So 80% of us will need social care in our old age. 20% of us might be walking up a hill, age 95, fully fit, heart attack, dead. But 80% of us are going to need social care. But within that 80%, we have no idea before it happens whether we're going to need a week, or a month, or three months, or 10 years. That's the plight that we face. And that's why it's striking how wise the population is. So many of the population might not be able to describe all of this in detail, but what they respond to is they say, "Oh, this is an insurance problem." Well, of course it's an insurance problem. Insurance problems are the ones which are characterized by not knowing how big the need that you face will be. And so rather than trying to cope with that need all on your own, you share that need with a large population, either through private insurance or through state insurance. So there's great wisdom in the crowd of people who have answered this, that they're supportive of an insurance-based approach, because that's the only approach that makes sense. Faced by something where you could need none, or a tiny bit, or you could need a massive amount, it makes no sense for everybody to try to save the massive amount. Most people couldn't possibly. Insurance is the right way forward. This was an insight that Winston Churchill had 120 years or so ago, in 1908, when he was working with William Beveridge on labor exchanges. He came up with a wonderful phrase; he said, "Social insurance brings the magic of averages to the rescue of the masses." And that is what insurance, whether it's private insurance or social insurance, does. So I'm not surprised, but very encouraged, that this group of the population recognizes the attraction of doing something together. There are technical reasons why it's very hard for the private sector to provide insurance against the tail-end risk, against the £2 million for a couple. The shortest way of putting that is that anybody on this call today could probably go and get health insurance for next year if they wanted to. But if they went to the health insurance and said, "Actually, we'd like health insurance for 40 years from now, and we'd like you to fix the premium now," the health insurance would say, "Funny joke, we're not playing that game." And that's really what we want in the case of long-term care insurance. We want to be able to provide many decades before the likely need that will be covered. The private sector can't cope with that particular form of risk, so they simply won't. The only way that we can take this forward is by the state intervening. And that's why it's rather encouraging that 96% of your respondents said they thought this was not something which should be left entirely to the private sector, and I think they are completely right.

It is striking, though, that in the responses that you got, there's evidence of not very much awareness of all of this. Greater awareness amongst those who have had personal experience. And one of the things that you see again and again in social care is that until members of a family have experienced a social care need in their wider family or friendship group, they often don't even really know what it means. And how would you? The word "social care" doesn't convey very much meaning. Once you've been through it, then you tend to be very aware of how serious the challenge is. And I think the challenge I would put to governments is it's their responsibility on all of our behalf to recognize the seriousness of all of this. And that's why, actually, I'm delighted that Louise Casey is going to take on this review. Of course, I'm pretty frustrated that yet again nothing's going to happen now. But I think in Louise Casey, we have somebody who will make very powerfully the argument for taking some action, and taking some action is what we really need.

That's a fascinating perspective, and I'm really struck by your point that we, I mean, pretty much all of the discourse about adult social care is a negative one. And actually, it is an expression of huge advances in our society and what's been achieved in terms of health and support over the last century or so. And it's important to kind of, I suppose, to, as you say, to reframe it like that, because this is a consequence of that model as it were. And therefore, what is it that we need to put in place to, and I love the word "flourish," so that people can flourish throughout their lives? It's like the term "health span" opposed to "life span." So, and I, it's a really important point because if we could look at it from that perspective, we might take a very, I suppose, a less negative and defensive position about it, perhaps. I don't know, it's one for us to think about. I'm just before before I, I, I ask Lucy to to come in from her experience, you, you've, you're, you're kind of you finished off the fact that, um, you know, delighted that that Baroness Casey is going to be taking for, uh, forward a further commission. And absolutely, we know, you know, from it, from, from history, that, uh, Baroness Casey will be very forthright in, in her views and what she thinks government, um, should do about problems. But why do you think, given your report in 2011, and the fact that this current government, and there have been moves in, you know, in that intervening time to do something, but the current government has has now created another commission, why is this such a difficult policy issue for governments to tackle? I wish I knew, because it really shouldn't be. And it has been a pretty extraordinary 14 years since we reported legislation based on our report has received the Royal Assent twice, once in 2014 and once in 2021, and it still hasn't happened. It's now been reneged on by the Conservative government from between 2015 and 2020. The Conservative government between 2021 and last year, and then the new Labour government, before they were the government, during the election campaign on the record, the Secretary of State for Health, sorry, the Shadow Secretary of State for Health and Social Care, then the person who is now the Secretary of State for Health, went on the record and said, "This is the certainty I want to give people, that we are going to go ahead with these reforms in October 2025." Then, about six weeks later, when he was Secretary of State for Health and Social Care, Rachel Reeves said, "Actually, no, we're not."

It is extraordinary. I think the relative lack of visibility is a large part of it. So MPs will often say it doesn't figure very large in my post bag. I think because by the time a family has been through an experience of social care, they're often so exhausted that the last thing they have the energy for is to become campaigners. So we all need to become campaigners on their behalf, because another thing that's often said, which is simply not true, is the amounts of money asked, certainly the amounts of money it will take, will grow, and that's because of our wonderful success. But they're tiny relative to what we spend, for example, on healthcare or education. Last year, earlier this year, we announced an increase in the health budget, which I fully support, of between 20 and 25 billion pounds for one year—no, for two years. The reforms that Boris Johnson's government legislated for, had they been implemented, would have cost three and a half billion pounds a year out of a total government budget of well in excess of 1,300 billion pounds a year. So the amounts of money are not large, but somehow the visibility of it, the exhaustion of those involved, the relative lack of voice of the one and a half million wonderful people who work in this sector, all means that something that we really should tackle, where at the moment we're failing one another appallingly, is still left on the shelf.

Thank you. I'm sure we'll return to that topic very shortly, but before we do, Lucy, you were there at the outset, as it were, with Sarandro in terms of his review and the commission reports, in terms of leading the deliberative research with the public. Any reflections on our findings and what you were encountering then?

So really, just reflecting, I mean, it's really interesting how similar the results are. And I think there are three areas that I would mention. In terms of awareness, as everyone has said, it's really something that's not top of mind, and that was very clear in 2011 when we did the research, until it is, as Andrew said, and then, you know, it's very much top of mind. And there is a lack of planning and a lack of preparedness. But what we found when we spoke to people as part of the deliberative research, you know, when you really talk to people about it, they are very interested, and they want to talk about it, and actually it is important to them. It's just not something they're thinking about every day. It's not a priority, even though they understand it's important. So I think that's one area.

The other is the area that Vicki spoke about, the upper capital limit, the safety net, the 23,250. And it was 23,250 back in 2011, so there'll certainly be some fiscal drag on that between now and then. It was seen as unfair then, it's seen as unfair now. And I think we, you know, we tried to speak to people about what would be a fair limit, and people were saying, "Well, maybe around the 50,000 mark seems fairer." And we obviously asked people as well, "You know, why is it unfair? What's driving it?" And I think that's quite a nuanced picture. There's a number of things underpinning that. You know, people feel that they've already paid into national insurance. But really, at the core of it, is this feeling that people don't want to feel they're being penalized for having saved throughout their lives. And they're really keen to be able to protect their assets, I mean, mainly their house, you know, and they don't want to see that running down. And that was something that really drove people's views of fairness around that capital limit. So that's another point.

And finally, I just think something about partnership. So again, we see here when you ask people who is responsible, they tend to say the state. But actually, when we spoke to people in some depth, it was clear that they very quickly and easily understand that there has to be a role for the individual, be that from a funding point of view for it to be sustainable, or in terms of just responsibility. You know, they get that. But I think as everybody's said, it's very hard for people to really think what do they do with that, you know, how do they, how do they prepare? And they really need to be supported and I think sort of behaviorally nudged to prepare. And I think that is really got to be a focus for government. So they were the main, the main points. I think there are some few other things about insurance that maybe we'll come to, but I think for now, that's the main point.

Thank you, Lucy. So just for everybody who's on the webinar, as I mentioned, we'll be asking the panel to answer questions. We've got a couple lined up which we'll start to go through. Any that we can just answer in short, we will do as well via the text facility. So kicking off, coming to you, Ben, was there anything, you know, kind of when you, when you look at the findings that we had, that surprised you?

I think the most surprising thing, Greg, was that there were no real surprises, that this hasn't changed in the time that, you know, in the intervening period between, as Lucy said, what we found from the deliberative work in 2010 and 2011 and now. Despite the political rhetoric, there's been a lot of discussion from sort of Theresa May and Boris Johnson, other governments up until now, with the Social Care Commission, about the importance of social care, and it's featured quite high in discussions about workforce planning and Brexit and immigration. It's also linked with, you know, one of the public's key policy concerns about the health service, is that, is that continuous care journey from becoming ill through to whatever care you need at any age. And people are, you know, part of the consequence of living longer is people are living with more and more conditions. So, so the need for care, both from a fairly sort of straightforward angle, in terms of, you know, having a visit at home a couple of times a day to help with washing and dressing and so on, through to the more complex needs that some individuals have from residential care, has been increasing over that period. And the public know all of that, I think, but that there haven't been any solutions presented or or put to the or implemented specifically. There have been solutions presented, and the Dilnot Commission is a good example of that. So, so with all of that going on, the fact that the views are still the same, I think has been the most surprising result from my perspective.

And Vicki, in one of your previous roles, you were involved in the auto-enrollment for pensions, which I think has been seen as a huge success in terms of a, you know, a kind of a real behavioral change in the population. And I question as to why, why don't we see the approach around social care? Are there differences?

I think there are. I was thinking about this as I was preparing for today, and I think that it's around, as Andrew mentioned, that perception of old age. So retirement funding, you see some joy in that. So you're saving in order to have a good quality of life when you get to that age, when you do eventually retire. So you're saving into something to enable a quality of life. So I think in terms of messaging and buy-in, it's probably a different situation. So it comes back to Andrew's point. I think that the perception that social care is a negative thing, it's about somebody coming in because you're incontinent, or it's because you need to be put in a home because you've got dementia, it's something you don't want to think about, because there doesn't seem to be a very positive element to it. Whereas I think with pension saving, it is about saving in order to have a good quality of life, or saving in order to be able to continue to do the things that you've done during your working life. So I think it is about how it's framed and how it's perceived, and that's potentially where there needs to be that shift. So I think Andrew is right in that there's a real sense of an image issue around the social care system that needs to be tackled, I think, before people would even begin to buy into something around saving for that eventuality.

Thank you. And Andrew, you, I mean, we've talked about, we touched on the, I suppose, the reticence of people to be making plans for it, because there is nothing that they can really plan for. But also, we know from our data, a certain like kind of, people being uncomfortable to talk about it. And I say, how do we, from your perspective, how do we overcome those issues, those, those kind of problems? Because as you say, there is a, there's wisdom in the, in the crowd, but the crowd is, is kind of not leaping forward in terms of helping to solve the solution, the problem.

Sorry. No, I think that's, that's right. And monitoring public interest in it, public interest tends to go up and down in this. So every now and again, we get a surge of interest, but they're not often sustained. My view about this is, I don't think we should by any means blame politicians always when we don't as a, as a nation or as a world get things right. It's, it's we're all responsible, but I do think this is an area where politicians have to take a lead. I think one of the most interesting things about the response to the Varian survey is that you do see in those responses, particularly when prompted, people making very sane, entirely rational judgments about what they think would be sensible. But on the whole, this is not an area where enough people feel expert that they're going to drive change. So I think we do need to look to our political leaders, both in government and in opposition parties, to try to help drive that forward. And in the end, a reflection that I think is probably right, or mainly right, is that action in a space like this depends at least in large part on the prime minister. Now, of course, prime ministers have a million and one things to do, but I think part of the wisdom that we see in Louise Casey is that Louise Casey has made a condition of taking on this commission that she reported directly to the prime minister. And I think that the nature of her interim report and her final report to the prime minister will be critical, but at least as critical will be his response. And I imagine that Baroness Casey, being a famously forthright person, will make it pretty clear what she thinks needs to be done. And I think that will put the prime minister in a position where he has to, you know, put up or shut up. And so I don't blame just politicians, but I think in a, in a challenge like this, where it is collective action of one form or another that's going to be required for us to get success, we need to rely on our politicians to help us. We're all responsible. We have to, events like this, which are building public understanding, building momentum, these are all important. But in the end, it's going to take a brave group of politicians to do something that will be to the benefit of everybody, and for which I think there's probably significant potential political credit, but the political credit will come after they've done it, not before. Yes, yes, which is always a tradeoff.

And I'm struck by, as we saw, the desire, and, and you know, significantly high numbers of people who desire for the state to be part of the solution on this. They very much see it, and again, I know from the detail of the data that there was, you know, there was little difference between say political persuasion in people. This was very much a, you know, the population as it were, saying this requires a state-led solution. And perhaps that's due to, as you've mentioned, the kind of the, the nebulous nature of it. Will I need it? Well, I won't. It's not like taking out private medical insurance for, I'm covered for this condition, this condition, this condition. I can choose to take the risk on that condition. It's, it's, it's much more vague and whether or not we'll, we'll need it. And so there is that, as you say, the challenge is, is how do we, how do you get your arms around that as an individual? And your kind of reflections on, Lucy was talking about, you know, the, and we, we saw it in the data about people's feeling of the, the, well, the, the kind of the, the savings cap is too low and, and having an infinite, an uncapped, the limit is, is, is unfair. You know, there is again, a sense of injustice that you can see, and some of the reasons that Lucy was talking about, people felt about it being unfair. I've worked all my life. But if I hadn't worked all my life and, you know, people's biases and stereotypes about all kinds of things come into it. But I, I, what was your, and I know you looked at this as part of your, your review. But what are your kind of perspectives now, 14 years later on, on those issues of means testing, of the, the kind of the upper and lower caps, as it were, or non-existent of an upper cap?

So I think, I think there are two really big problems facing the existing system in the UK. The first is that the means test decision, which has to be the bedrock of of a kind of decent provision, I mean, if we can't even look after those who haven't got any resources of their own, then we're failing. That system is simply inadequately funded. And for the last 10 years, just about every year, the Treasury has allocated emergency additional funding to it. Well, if you're having to allocate emergency additional funding every year, then that should be telling you something, that your fundamental underlying model is bust. And so the grown-up thing for governments, and this is governments of all political persuasions, will be to set a funding program for the means tested system in the medium term that actually came close to being enough to pay for it decently. At the moment, we end up with extra money being announced in the year, being given to local authorities who then can't spend it very efficiently because if you're given money halfway through the year to spend in that year. So it's staggeringly immature. One aspect of the means-tested system that is also, that just seems hard to defend, is the £23,250 capital limit, which has been there for the best part of 20 years now, unchanged. If you've got assets below that level, the state will pay, typically, most of your costs, above nothing. Well, that doesn't seem like a very well-designed means test. Means testing, I think, can be a very effective and powerful mechanism. I support it in many cases, but having a means test with a literal cliff edge, I mean, a literal cliff edge, is not helpful and leads to people getting letters from solicitors saying, "Where there's a will, there's a way to avoid the social care means test." You know, we need to sort all of that out.

So our existing means-tested system is not well-structured, and it's wrong. That's one huge problem. But then there's the other problem, which is all of the rest of us. So were it possible to get private, well, do a thought experiment. Would we ever say the problem with having a car crash is that you lose your home? Well, no, because actually, we force people to have car insurance. Would we ever say the problem with your house burning down is that you might lose your home? No, because people, they're not forced to take out, but they can take out insurance and do. The reason the lack of any upper limit matters here is that there is no private insurance possibility. So it's no wonder that 70%, 69% of people aren't planning, because there's nothing they can do. So the whole point here is that there's a massive market failure. That's not, I'm not being critical of markets, it's simply not feasible for the private sector to ensure this catastrophic risk. Only the state can do it.

The reason that the state can do it is worth reflecting on. It's because the state can change the rules. So the state can introduce a system, and if it turns out that it's more expensive, it can raise the price or reduce the generosity. You're not allowed to do that if you're a private insurer. If you've written a contract, that's the end of it. Our state pension system in the UK has, that's had been done to it nine or ten times in the post-war period. Quite a lot of women on this call, they're going to end up receiving their state pensions much later than they might have thought they were going to when they began their working life. And on the whole, we recognize, and actually, many of the men will do too, we recognize that it's got more expensive. The Turner Review looked for that. We changed the rules. You can't do that if you're a private insurer. So yeah, so that does need to be done. And it is really critical that we take the terrifying risk away from people, because it's that that stops people from engaging in spending early on in their social care need, or indeed before it, to reduce it.

So we see many people hoarding not very large amounts of wealth, but hoarding it in case they have a high social care need. We desperately need to take that fear away. And that's the only way that we'll end up being able to pay the wonderful people who deliver the care properly. At the moment, because everybody is terrified, or all but the richest tiny proportion of the population is terrified that they might run out of money, everybody wants to pay the least. If we can take that fear away by providing insurance, social insurance reform, then we have a chance of both taking away the fear that individuals experience, but also creating a social care sector which can be vibrant, can help the economy grow. Wouldn't it be great for the UK to be leading the world in social care innovation? And we could do that pretty cheaply if we just had the courage and the vision to get on with this.

I mean, on your point about the care sector, you know, none of this recognizes unpaid carers either. And you know, which is a population who could also be benefited by, you know, as you say, the government can change the rules, so it's in a far better position to oversee a structured system for this. You know, I believe that there's nearly 5 million unpaid carers in the country doing wonderful caring, and also typically doing it very happily, very happy to do it. But at the moment, the system gives them no sense that there'll be a respite. So most people will be very happy to provide care in an emergency, provide care for a short period. But know that if the care need goes on for a very long time, they're going to need support. And at the moment, there's no, there's no light at the end of that tunnel for people. And so the burden that that can create for informal carers can become enormous.

It's perhaps worth saying here, and Vicki mentioned incontinence earlier on, we don't talk about incontinence anything like enough. Incontinence, and particularly double incontinence, is often the point at which informal care becomes genuinely very difficult, difficult for people providing care, but also difficult for the person needing the care. And there can be all sorts of causes of incontinence. It's not the case that your life has to stop being a good life if you're having incontinence challenges, but it is the case that you're going to need help and support to manage it, just as you would need help and support in any other health-related problem. So, in many areas here, we just need to be a bit more open, a bit more honest with one another, and we can make lives better and longer and more fruitful. And it's a great shame that we haven't. People often ask me, "Am I not frustrated that this has been legislated for twice and not happened?" And no, I have no sense of that at a personal level. What makes me cross is that we've failed another 15 generations of families since 2011. We've let one another down. We are now as a society, something that we could resolve with a small fraction of 1% of our national income, we're not doing. We're letting ourselves down. And the glory of the kind of research that you and your team have done is that people understand this. They may not always be able to explain it clearly in public policy terms, but they have a sense that this is something to do together. Well, let's do it.

So, on that point, you mentioned being an international leader in that. Are you aware of any countries where you think, you know, they've got it right, or much better in terms of their system, you know, one that doesn't just rely on extended family members? So most of the wealthier countries have a version of a system, and most of them are a bit more generous than the UK's. The UK is unusual in having an exclusively means-tested system. There aren't many countries that aren't facing significant challenges in this area, challenges of success, I think. So those countries that have in the past said they've got fully funded, free-at-the-point-of-use systems, they're mainly finding enormous public finance constraints affecting them. And so in many of those countries, what's actually being delivered isn't what was promised, and that's leading to big bills for some people, a great deal of frustration. Interestingly, Australia has recently introduced a version of the sorts of reforms that we advocated back in 2011, so I'd be very interested to see how that plays out.

The countries that have been most successful thus far have tended to be the social insurance-based countries. And that's because by having a social insurance-based thing, they've had a flow of funds that has at least had social care's name on it, and that has helped. But as I say, at the moment, the demands in those countries are rising, and so they're facing a question of whether they increase the contribution rates, which politicians are often anxious about, or fail to deliver. And this is a very clear case of something which as we get older is going to cost more, and that's always, that's always a challenge for governments. And it's a particular challenge here because it's only the public sector that can do the risk pooling. If we don't, if we don't have public sector involvement, we're all left essentially trying to save enough to pay for the worst-case scenario. None of us would dream of keeping a savings pot large enough in case we had a bad car accident, or large enough in case our house burned down, or large enough in case we had a healthcare need. We have an NHS that deals with a healthcare need, private insurance that deals with the car and the house burning down. This is the one big risk that we all face where we're just on our own. And it's, to use a technical, perhaps slightly subtle term, nuts.

Yeah, thank you. I do have, there's two questions I really want to try and kind of get answered. The last one I will save for you, Sir Andrew, if that's okay. The first one is, and this is to anybody on the panel who wants to jump in on the private sector question, "Does the panel think a greater proportion of the sector should be provided by not-for-profit providers, either public or private?" Does anybody want to respond on that?

I think that, that certainly plays into the debate about the, and we've seen it with pharmaceutical companies and others, the public have more confidence in not-for-profit. So I think that is part of the, part of the solution. But yeah, as to exactly what the mix is, that is a more detailed question than I think we can, we have time to answer now. Thank you very quickly, if I could just jump in, just from the previous research. We explored private insurance in quite some detail, and I think to Ben's point, in terms of trust, there was some sense of perhaps not trusting insurers to pay out. Yes, so if not-for-profit provides greater confidence, that would be a good thing. Thank you, Lucy.

And so Andrew, just coming back to you for the last kind of comment. So you've, you know, we've, you've set out very clearly a kind of a, you know, reasons why we need to tackle this burning platform. We have spending review announcements in two weeks' time. We all are aware of the kind of the fiscal situation, geopolitical issues that make it life more difficult for our government. So the question is, how do we convince the Treasury to make this a priority? The Casey Commission won't publish final recommendations till 2028. So it's kind of, it's back to your point on, so how do we, how do we get this up the priority list? Because as you say, it's a relatively small amount of money in the scheme of things.

So yeah, I mean, Baroness Casey's final report is not due till 2028. She's got an interim report in a bit less than a year, and what I really hope is she uses that to make the point about the scale, but also importance of this. And in the end, I think at a purely governmental level, it will come down to, is the Prime Minister, I don't particularly blame the Treasury. The Treasury have always been a blocker for this. It's, but that's kind of their job, they're a finance ministry. Their job is to say no, and they're not going to be supportive of expansions of the envelope of government. But for that to work, we need countervailing forces. And in particular, we need a Prime Minister, and it's pretty clear that when Boris Johnson was Prime Minister, and was strongly supportive of social care reform, it was something he really did care about, the Treasury said, the Treasury response appears to have been, "Well, if you want to do that, you're going to have to put up taxes." And he said, "Well, knock yourself out," which is how we got the Health and Social Care Levy, which would, I, most of the Health and Social Care Levy would have gone to the health service, a small part of it would have gone to the social care reforms that his, and let me say, the social care reforms he was proposing were not exactly what I would have wanted. They were meaner in a number of ways, one at least of which was very important and made the whole thing less progressive. But still, it would have been change. But it was, I think the Treasury may not have expected him to say, "Okay, if you say we're going to put up taxes, let's put up taxes." But he did. And had he continued as Prime Minister for another two months, then a set of reforms would have been introduced. When he ceased to be Prime Minister, first the Health and Social Care Levy was abolished by the Liz Truss government, and then the Rishi Sunak government pulled the plug on going ahead with the reforms. So I think to get this done, we are going to need political leadership at the highest level. Yeah, and there is a value for money argument about people's productivity as they enter later stages of life with the right support, so that, that can be made. So thank you. I'm aware we're just over time. It has been an absolutely fascinating discussion. Thank you very much to all of our panelists, and particularly Sir Andrew, thank you for your time. It's been incredibly insightful. If anybody wants to follow up with us on more detail on the research that we did, please feel free to reach out. We will be publishing on our website access to the data tables and the full polling. And thank you for attending, and look forward to further developments and further debates in this space. Thank you, everybody. Thank you, Sir Andrew. Thanks. Thank you. Bye-bye.